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General NPI Number Information
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NPI Number | 1437827300
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY EYE CARE LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/26/2021
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Provider Practice Location Address
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Address Line | 120 JILL DR
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City | BEREA
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State | KY
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Zip | 40403-1677
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Country | US
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Telephone | 859-985-8641
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Fax | 859-985-8867
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Provider Business Mailing Address
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Address Line | 2048 MOSS CREEK CT
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City | RICHMOND
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State | KY
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Zip | 40475-8983
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Country | US
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Telephone | 859-200-4489
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KRISTINA BURTON
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Credential | OD
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Telephone | 859-985-8641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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